69(7):1157-65. [Medline]. A double-blind randomized pilot study comparing quetiapine and divalproex for adolescent mania. Chicago, IL: The 153rd Annual Meeting of the American Psychiatric Association; May 14, 2000. 198(4):284-288. [39] interpersonal therapy (IPT), dialectical behavior therapy (DBT), cognitive behavior therapy (CBT), family therapy, group therapy. Am J Psychiatry. Although it is common for children and adolescents with bipolar disorder to be treated with medications, risperidone, ziprasidone, aripiprazole, valproate, and lithium (in patients as young as 12 years) have received approval from the US Food and Drug Administration (FDA) for this application. Cognitive flexibility in phenotypes of pediatric bipolar disorder. These are usually prescribed along with a mood stabilizer or antipsychotic—generally not as a standalone, since antidepressants can't manage the manic symptoms experienced by a child with bipolar disorder and may even activate or worsen mania when used alone. In recent years, it's become a controversial diagnosis. 108(3):297-301. Miklowitz DJ, Schneck CD, Walshaw PD, Singh MK, Sullivan AE, Suddath RL, et al. [Medline]. Sometimes a child’s symptoms may change, or disappear and then come back. In those whose condition does not respond to lithium, sodium divalproex is generally the next agent of choice. 370(2):119-28. Psychosocial functioning among bipolar youth. J Am Acad Child Adolesc Psychiatry. The mainstay of treatment for bipolar disorder in children and adolescents is pharmacotherapy . [Medline]. 2017;19:524-543. Depressive episodes are frequently the first presentation of bipolar disorders in youths. Johnston JA, Wang F, Liu J, Blond BN, Wallace A, Liu J, et al. [Medline]. Borue X, Mazefsky C, Rooks BT, Strober M, Keller MB, Hower H, et al. Danielyan A, Pathak S, Kowatch RA, Arszman SP, Johns ES. 46(7):820-30. Toward the Definition of a Bipolar Prodrome: Dimensional Predictors of Bipolar Spectrum Disorders in At-Risk Youths. [Medline]. Lithium carbonate is effective in approximately 60-70% of adolescents and children with bipolar disorder and remains the first-line therapy in many settings. Atypical antipsychotics for acute manic and mixed episodes in children and adolescents with bipolar disorder: efficacy and tolerability. Kendall T, Tyrer P, Whittington C, Taylor C. Assessment and management of psychosis with coexisting substance misuse: summary of NICE guidance. [Medline]. Copeland WE, Shanahan L, Costello EJ, Angold A. Childhood and adolescent psychiatric disorders as predictors of young adult disorders. [Medline]. 2016 Sep. 46 (12):2467-84. 2011 Mar. [Guideline] Gleason MM, Egger HL, Emslie GJ, Greenhill LL, Kowatch RA, Lieberman AF, et al. The findings from the controlled trial of asenapine for the treatment of pediatric bipolar disorder were recently reported (N = 403). Randomized controlled trials have recommended individual cognitive behavior therapy in children and adolescents to focus on suicide prevention, as well as to monitor and manage medication if family conflict and negative expressed emotions are absent. The goals of inpatient or outpatient treatment are to control and minimize symptoms of bipolar disorder, to prolong normal mood states or euthymia, to minimize the number of needed hospitalizations, to eliminate or minimize medication adverse effects to a tolerable level, and to optimize the quality of life (QOL) for the patient. What is Pediatric Bipolar Disorder? Effects of Family-Focused Therapy vs Enhanced Usual Care for Symptomatic Youths at High Risk for Bipolar Disorder: A Randomized Clinical Trial. Joseph MF, Frazier TW, Youngstrom EA, Soares JC. Strober M, DeAntonio M, Schmidt-Lackner S, Freeman R, Lampert C, Diamond J. However, this agent should be used carefully in patients with bipolar disorder because of its long half-life and because of its potential to cause significant weight gain and/or to exacerbate manic symptoms. An fMRI study of the interface between affective and cognitive neural circuitry in pediatric bipolar disorder. 17(6-7):440-7. 2018 Jul/Aug. Y1 - 2011/3. J Am Acad Child Adolesc Psychiatry. Bipolar Disord. Hippocampal subfield volumes in children and adolescents with mood disorders. [Full Text]. 2017 Jan. 2 (1):85-93. [Medline]. Because of the slow-on and slow-off action of clonazepam, the risk of abuse is lower with this drug than with fast-acting benzodiazepines such as lorazepam and alprazolam (Xanax). Pediatrics: Developmental and Behavioral Articles, https://www.medscape.com/viewarticle/893542, American Academy of Child and Adolescent Psychiatry, Pleasure in violating societal norms, especially if not caught, Episodic disturbances such as decreased need in mania, Not known to be disrupted except with substance abuse, Pressured or rapid in mania; slow in depression, May engage in predatory or reactionary acts, Agitated in mania or mixed states; retarded in depressed states, ADHD—attention deficit/hyperactivity disorder. J Psychiatr Res. 2 Youths with bipolar I disorder, manic or mixed episode participated in a 3-week double-blind, placebo-controlled trial. All ECT treatments require the presence of an anesthesiologist or anesthetist throughout the administration of therapy. Reconsidering Insomnia as a Disorder Rather Than Just a Symptom in Psychiatric Practice Click to enlarge page Awareness of the prevalence and impact of bipolar disorder in pediatric patients has grown in recent years. [Medline]. Omega-3 fatty acid monotherapy for pediatric bipolar disorder: a prospective open-label trial. Decreased protein kinase C (PKC) in platelets of pediatric bipolar patients: effect of treatment with mood stabilizing drugs. Stay focused on your goals. family functioning, satisfaction w treatment 35 children, 54%depressed, 46% bipolar spectrum 165 children, 70% bipolar spectrum, 30% depressed 3 MF-PEP Effectiveness trials: feasible, improved mood 40, 41 and XX children—mixture of D & B 3 IF-PEP RCTs: improved mood 20 children, 100% bipolar … 342:d1351. [Medline]. Birmaher B. Longitudinal course of pediatric bipolar disorder. Your child will need to follow the treatment plan outlined by her care team, and any changes should be carefully discussed among all members of her treatment team. Correll CU. J Am Acad Child Adolesc Psychiatry. [Medline]. [69, 70, 71, 72, 73], Family conflict may decrease response to medication treatment and so should be addressed in a timely fashion. Cognitive-behavioral therapy for suicide prevention (CBT-SP): treatment model, feasibility, and acceptability. J Am Acad Child Adolesc Psychiatry. Family-focused therapy with a cognitive behavioral component is encouraged, in that having a child with bipolar disorder requires the parents, the identified child, and siblings to adjust to the impact on the family system, necessitating a focus on improved communication. Atypical antipsychotic agents may be used due to demonstrated antimanic properties in pediatric patients with bipolar disorder who present with or without psychosis. Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug ReferenceDisclosure: Nothing to disclose. Dev Psychopathol. Garrett A, Chang K. The role of the amygdala in bipolar disorder development. [Full Text]. [Guideline] Kowatch RA, Fristad M, Birmaher B, Wagner KD, Findling RL, Hellander M. Treatment guidelines for children and adolescents with bipolar disorder. Olanzapine and pediatric bipolar disorder: evidence for efficacy and safety concerns. T1 - Treatment of pediatric bipolar disorder. Although the condition responds to treatment in most cases, bipolar disorder is generally seen as a chronic (long-lasting) disease that may come and go for many years. The principles of pharmacotherapy include use of medication with a low (single digit below 10) desirable NNT (number needed to treat) compared with placebo and high NNH (number needed to harm; above 10 desirable), as the NNH should be larger than NNT. [Medline]. Benzodiazepines, such as clonazepam (Klonopin) and lorazepam (Ativan), are generally avoided in children because of the long-term risk of dependence, but they may be temporarily useful (< 2 wk maximum) in restoring sleep or in modulating irritability or agitation not caused by psychosis. #1 Ranked Children's Hospital by U. S. News & World Report, Advocating Success for Kids (ASK) Program, Visit our “For Patients and Families” page, Parents of Bipolar Children Online Support Group, Pediatric Bipolar Awareness Facebook Page, CopeCareDeal: A Mental Health Site for Teens, Young men and young women may have certain concerns that are specific to their genders, and some concerns that they share. Bipolar disorder is a mental health condition, often with two phases: mania and depression. Transl Psychiatry. 2011 Nov. 50(11):1173-1185.e2. Characteristic Behaviors Associated With Bipolar Disorder, DMDD, ADHD, and Conduct Disorder, Table 2. [Medline]. At the Pediatric Mental Health Institute at Children's Colorado, we adhere to best practices for the treatment of bipolar disorder, which includes a combination of medication and psychotherapy. Biederman J, Faraone S, Milberger S, Guite J, Mick E, Chen L, et al. Mood stabilizers are medications that stop the rapid shift from high to low moods and back again. 2008 Mar. In general, the treatment of bipolar disorder may be thought of as a 4-phase process: (1) evaluation and diagnosis of presenting symptoms, (2) acute care and crisis stabilization for … The efficient metabolizing and clearance systems of young individuals have 2 important consequences: Anticipated peak plasma drug levels may be higher in young patients than in adults. Studies of complementary medications, such as omega-3 fatty acids (PUVA) to reduce symptoms of depression with less risk of mania and herbal preparations to increase sleep, are ongoing and appear promising; however, data are still being gathered regarding long-term safety considerations for children and adolescents. Conference Coverage, You are being redirected to Am J Psychiatry. Dialectical behavior therapy for adolescents with bipolar disorder: a 1-year open trial. Treatment for bipolar disorder in children should involve a combination of medication and talk therapy. [Full Text]. Here at Children's, our Psychopharmacology Clinic is devoted to helping children, families and clinicians incorporate medication into a treatment plan. There is medical debate about whether bipolar disorder should be diagnosed in children as currently, there are no specific symptoms for bipolar disorder in children, only for adult bipolar disorder. [80]. Hooley JM, Miklowitz DJ. A. PY - 2011/3. March 7, 2018; Accessed: March 7, 2018. Bipolar Disord. The early course of bipolar disorder in youth at familial risk. Findling RL, Correll CU, Nyilas M, et al. [75], Family Focused care also appeared to delay episodes of bipolar depression as compared to regular enhanced care. [Medline]. However, the current classification for bipolar disorder is based on research conducted primarily on adults. 2016 Jul 1. Brotman MA, Skup M, Rich BA, Blair KS, Pine DS, Blair JR, et al. Pediatr Clin North Am. Association of Comorbid Mood and Anxiety Disorders With Autism Spectrum Disorder. [29, 62]. This treatment also has no risk of potential overdose because it is a nonmedication treatment. Biol Psychiatry Cogn Neurosci Neuroimaging. PLoS One. Disruptive mood dysregulation disorder and chronic irritability in youth at familial risk for bipolar disorder. [61]. Steiner H. Evaluation and management of violent behavior in bipolar adolescents. Duax JM, Youngstrom EA, Calabrese JR, Findling RL. The most commonly prescribed classes of medication are mood stabilizers and antipsychotics; however SSRIs (selective serotonin reuptake inhibitors) and stimulant … Adults with bipolar disorder may also live with substance abuse, eating disorders, anxiety, and disrupted sleep rhythms, which are not typical in children with bipolar disorder. Once a therapeutic level and response to the mood stabilizer are attained, an antidepressant may be considered as additional treatment needed for the current state of depression, with close monitoring for antidepressant-induced mania. This is not clear at this time. Brief interpersonal psychotherapy for depressed mothers whose children are receiving psychiatric treatment. Medscape Education, 2010 The treatment of adolescent or juvenile patients with bipolar disorder is modeled after treatments provided to adults; it appears that adult bipolar disorder is continuous with pediatric bipolar disorder. 2007 Jul. 2007 Aug. 68(8):1301-2. 2. ECT is often initially administered on an inpatient basis because it is most frequently used in patients with severe or refractory disease, who are likely to require hospitalization more often. Medications for Pediatric Bipolar Disorder: Common Adverse Effects and Special Concerns (Open Table in a new window), GI distress, lethargy or sedation, tremor, enuresis, weight gain, alopecia, cognitive blunting, 10-30 mg/kg/d; dose must be adjusted by monitoring serum level and patient response; up-titrate on twice-daily schedule, Hypothyroidism, diabetes insipidus, toxic in dehydration, polyuria, polydipsia, renal disease; drug-drug interactions and sodium intake may alter therapeutic serum levels, Sodium divalproex/valproic acid (Depakote, Depakene), Sedation, platelet dysfunction, liver disease, alopecia, weight gain, 15-30 mg/kg/d; dose must be adjusted by monitoring serum levels; up-titrate on twice- or thrice-daily schedule, Elevated liver enzymes or liver disease, drug-drug interactions, bone marrow suppression, Less likely to cause prolactinemia than risperidone; may cause Stevens-Johnson syndrome; as with other atypical antipsychotics, may cause tardive dyskinesia, dystonia, parkinsonism, hyperglycemia; use with caution in seizure disorders and cardiac disorders, including problems with cardiac contractility and electrical activity, 2 mg once daily can be increased to 5 mg, 10 mg, 15 mg, to a maximum of 30 mg to start, titrate upwards at weekly to bimonthly intervals, levels may need to be adjusted in patients who are concurrently receiving lamotrigine, topiramate, Depakote, lithium, or other serotonin-norepinephrine reuptake, selective serotonin reuptake, or cytochrome P450 inhibitors, Do not administer if there is an unstable seizure disorder, Suppressed WBCs, dizziness, drowsiness, rashes, liver toxicity (rare), 10-20 mg/kg/d; dose must be adjusted by monitoring serum blood levels; up-titrate on twice-daily schedule, Drug-drug interactions, bone marrow suppression, 2.5 mg SL q12h initially; may increase to 5 mg SL q12hr after 3 days and to 10 mg SL q12hr after 3 additional days, Pediatric patients are more sensitive to dystonia with initial dosing when recommended escalation schedule not followed, Risperidone (Risperdal, Risperdal Consta, Risperdal M-Tab), 0.25 mg bid or 0.5 mg at bedtime initially; titrate as tolerated to target dosage of 2-4 mg/d; not to exceed 6 mg/d, 50 mg bid initially; titrate as tolerated to target dosage of 400-600 mg/d, Decrease dosage with hepatic impairment, may cause neuroleptic malignant syndrome or hyperglycemia, Olanzapine (Zyprexa, Zyprexa Zydis, Zyprexa Relprevv), Weight gain, dyslipidemia, sedation, or orthostasis, 2.5-5 mg at bedtime initially; titrate as tolerated to target dosage of 10-20 mg/d, Metabolic syndrome, extrapyramidal symptoms, 0.01-0.04 mg/kg/d PO at bedtime or divided bid, Caution with renal/hepatic impairment and asthma, Headache, nausea, insomnia, anorexia, anxiety, asthenia, diarrhea, somnolence, 10 mg PO qd; may consider increasing to 20 mg/d after 1 wk, Long half-life; potential to exacerbate manic symptoms when not coadministered with an antimanic or mood-stabilizing agent, Off-label: 20 mg PO at bedtime; can increase to 40 mg (not to exceed 60 mg), usually in 2 divided doses for children, Risk of sudden cardiac death due to torsades des pointes due to prolonged QT prolongation, which makes this medication undesirable for individuals with a family history of cardiac sudden death related to cardiac conduction abnormalities. 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